LITERATURE REVIEW
• Advisor to Esteve Teijin in the area of
home respiratory therapy
• I have no other relevant financial
relationships to d...
• I will not be discussing off-label uses.
INDEX
• Pneumonia
• Lung Cancer
• Pulmonary Fibrosis
• Pneumonia
• Lower respiratory tract infection the third most common cause of death in
the world (3.5 million deaths/year)
• Streptoc...
Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
PNEUMONIA
PNEUMONIA
PUBMED search March 2014. Number of publications related to the topic.
• PCV7 introduced in USA in 2000
• Major reduction in the incidence of invasive disease in all age
groups
• Aim: the early...
• National Inpatient Sample (NIS)
• 1050 hospitals in 44 States
• ICD-9-CM/ pneumonia as 1st diagnosis or meningitis, sept...
PNEUMONIA
Average Annual Rates of U.S. Hospitalizations for Pneumonia before and after the Introduction of PCV7, According...
Hospitalizations for Pneumonia among U.S. Children.
PNEUMONIA
Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2...
PNEUMONIA
The annual rates of hospitalization for pneumonia from 1997 through 2009.
Griffin et al. N Engl J Med Volume 369...
PNEUMONIA
Hospitalizations for Pneumonia among U.S. Adults.
Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
PNEUMONIA
Differences in Rates of Hospitalization for Pneumonia from Any Cause 3 Years before and 7 to 9 Years after the
I...
Rates of In-Hospital Death Related to Pneumonia from Any Cause 3 Years before and 7 to 9 Years after the
Introduction of P...
PNEUMONIA: CONCLUSIONS
PNEUMONIA
• Declines in hospitalizations for childhood pneumonia were
sustained during the decade a...
PNEUMONIA: MESSAGES
PNEUMONIA
Hammit et al. J Infect Dis. Volume 193(11):1487-94 Apr 27,
2006
Weinberger, Lancet 2011; 378...
INDEX
• Pneumonia
• Lung Cancer
• Pulmonary Fibrosis
• Lung Cancer
• Lung cancer 1.59 million deaths in 2012
• More individuals die from lung cancer than from colon, breast
and prostate can...
LUNG CANCER
RCT’S:
• DANTE A randomized study of lung cancer screening with spiral
computed tomography: three-year results...
Inclusion criteria:
• 55–74 years
• ≥30 pack-years
• Former smokers (within the previous 15 years)
• LDCT vs. chest radiog...
NLST Research Team, N Engl J Med 2011;365:395-409.
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
LUNG CANCER
PUBMED search March 2014. Number of publications related to the topic.
LUNG CANCER
• LDCT diagnosed more cancer (1,1% vs 0,7%)
• More stage I Ca in LDCT group
• Tendency of stage-shift
• Sensibility of LDC...
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
Data extracted from original
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
Data extracted from original
LUNG CANCER
NLST Research Team, N Engl J Med 2013;368:1980-91.
Sensitivity, specificity and positive predictive value for ...
LUNG CANCER
NLST Research Team, N Engl J Med 2013;368:1980-91.
T0; Number of patients diagnosed of lung cancer according t...
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
T1; Number of patients diagnosed of lung cancer acording to Stage.
Data ...
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
T2; Number of patients diagnosed of lung cancer acording to Stage.
Data ...
LUNG CANCER
NLST Research Team, N Engl J Med 2013;368:1980-91.
T1; PPV according to lung nodule size.
Data extracted from ...
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
T2; PPV according to lung nodule size.
Data extracted from original
LUNG CANCER
Aberle, N Engl J Med 2013;369:920-31.
T0; PPV according to lung nodule size.
Data extracted from original
• Low-dose CT detects more lung cancers than radiography
• Stage shift toward early-stage in non–small-cell lung cancers
•...
• Selection criteria
–Detterbeck, CHEST 2013; 143(5)(Suppl):e78S–e92S
–Kovalchik, N Engl J Med 2013;369:245-54
• Results m...
Benefits
• Effect on mortality
• Effect on smoking
behavior
Harms
• False positives
• Diagnostic procedure
complications
•...
INDEX
• Pneumonia
• Lung Cancer
• Pulmonary Fibrosis• Pulmonary Fibrosis
PULMONARY FIBROSIS: INTRODUCTION
PULMONARY FIBROSIS
Navaratnam et al., Thorax 2011;66(6):462-7
PULMONARY FIBROSIS
Kern et al., Ann Intern Med 1998;129(4):261-72
PULMONARY FIBROSIS
Taken from: http://cxjinxing.en.alibaba.com/product/514495564-213102141/Nylon_flock_powder.html
PULMONARY FIBROSIS
Turcotte, CHEST 2013; 143(6):1642–1648
PULMONARY FIBROSIS
Navaratnam et al., Thorax 2011;66(6):462-7
PUBMED search March 2014. Number of publications related to ...
PULMONARY FIBROSIS
Turcotte, CHEST 2013; 143(6):1642–1648
PULMONARY FIBROSIS
Turcotte, CHEST 2013; 143(6):1642–1648
Natural history of FWL disease. Adapted from original
PULMONARY FIBROSIS
Turcotte, CHEST 2013; 143(6):1642–1648
• In summary, the natural history of FWL includes complete resolution;
persistent, but stable ILD with a restrictive pulmo...
PULMONARY FIBROSIS
• Natural history of the interstitial lung diseases is not uniform and even
can be reversed
• It is imp...
PULMONARY FIBROSIS
Thanks a lot!
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Pulmonary review - Chest World Congress Madrid 2014

  1. 1. LITERATURE REVIEW
  2. 2. • Advisor to Esteve Teijin in the area of home respiratory therapy • I have no other relevant financial relationships to disclose Conflict of interest
  3. 3. • I will not be discussing off-label uses.
  4. 4. INDEX • Pneumonia • Lung Cancer • Pulmonary Fibrosis • Pneumonia
  5. 5. • Lower respiratory tract infection the third most common cause of death in the world (3.5 million deaths/year) • Streptococcus pneumoniae major cause of morbidity and mortality worldwide (bacteremia, meningitis, pneumonia and acute otitis media) • Serious disease mainly in children under two years of age and in elderly • 1.6 million deaths / year estimated in 2005 (0.7–1 million children) • PPSV23 less effective than expected • Pneumococcal strains nonsusceptible to penicillin and erythromycin could have reached 41% by 2004 in the absence of a PCV PNEUMONIA: INTRODUCTION WHO, 2013 (http://www.who.int/mediacentre/factsheets/fs310/en/index.html). Jackson LA. An OficialPublication of the Infectious Diseases Society of America 2008;47:1328–38. Richard G. et al. N Engl J Med 2014;370:543-51. McCormick et al. AW Nat Med 2003;9:424-30. PNEUMONIA
  6. 6. Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013 PNEUMONIA
  7. 7. PNEUMONIA PUBMED search March 2014. Number of publications related to the topic.
  8. 8. • PCV7 introduced in USA in 2000 • Major reduction in the incidence of invasive disease in all age groups • Aim: the early observed reductions in hospitalizations for pneumonia were sustained throughout the first decade of PCV7 use? PNEUMONIA PNEUMONIA: BACKGROUND Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  9. 9. • National Inpatient Sample (NIS) • 1050 hospitals in 44 States • ICD-9-CM/ pneumonia as 1st diagnosis or meningitis, septicemia or empyema + pneumonia as 2nd PNEUMONIA PNEUMONIA: METHODS/DATA SOURCES Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  10. 10. PNEUMONIA Average Annual Rates of U.S. Hospitalizations for Pneumonia before and after the Introduction of PCV7, According to Age Group. Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  11. 11. Hospitalizations for Pneumonia among U.S. Children. PNEUMONIA Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  12. 12. PNEUMONIA The annual rates of hospitalization for pneumonia from 1997 through 2009. Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  13. 13. PNEUMONIA Hospitalizations for Pneumonia among U.S. Adults. Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  14. 14. PNEUMONIA Differences in Rates of Hospitalization for Pneumonia from Any Cause 3 Years before and 7 to 9 Years after the Introduction of PCV7. Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  15. 15. Rates of In-Hospital Death Related to Pneumonia from Any Cause 3 Years before and 7 to 9 Years after the Introduction of PCV7. PNEUMONIA Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  16. 16. PNEUMONIA: CONCLUSIONS PNEUMONIA • Declines in hospitalizations for childhood pneumonia were sustained during the decade after the introduction of PCV7. • Substantial reductions in hospitalizations for pneumonia among adults were also observed. Griffin et al. N Engl J Med Volume 369(2):155-163 July 11, 2013
  17. 17. PNEUMONIA: MESSAGES PNEUMONIA Hammit et al. J Infect Dis. Volume 193(11):1487-94 Apr 27, 2006 Weinberger, Lancet 2011; 378: 1962–73 Letters to the editor. NEJM 369;17 nejm.org october, 2013 Singleton, JAMA. 2007;297:1784-1792 • Probably the “herd” effect protects elderly people – Hammit et al. J Infect Dis. Volume 193(11):1487-94 Apr 27, 2006 • Consequences of Serotype replacement There is not enough data to evaluate the impact – Weinberger, Lancet 2011; 378: 1962–73 • Species replacement Other pathogens like Staphylococcus aureus is a concern – Reed A. Siemieniuk M.D. Letters to the editor. NEJM 369;17 nejm.org october, 2013 • Pneumonia complications (Empyema) seems to arise – Alessando Amaddeo. Letters to the editor. NEJM 369;17 nejm.org october, 2013 • We will have to wait to see the effects on mortality • A decade of PVC13 is open
  18. 18. INDEX • Pneumonia • Lung Cancer • Pulmonary Fibrosis • Lung Cancer
  19. 19. • Lung cancer 1.59 million deaths in 2012 • More individuals die from lung cancer than from colon, breast and prostate cancer combined • Rx radiographs and sputum screenings didn’t meet the expectations, mortality? • IELCAP results opened the door to RCTs WHO Fact sheet N°297. Feb 2014. http://www.who.int/mediacentre/factsheets/fs297/en/ Detterbeck, CHEST 2013; 143(5)(Suppl):e78S–e92S Shlomi, Eur Respir J 2014; in press LUNG CANCER: INTRODUCTION LUNG CANCER
  20. 20. LUNG CANCER RCT’S: • DANTE A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. • DLCST CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. • NELSON Volumetric computed tomography screening for lung cancer: three rounds of the NELSON trial. • ITALUNG Four-year results of low-dose CT screening and nodule management in the ITALUNG trial. • NLST NLST Research Team • >86.000 patients included in total Am J Respir Crit Care Med. 2009 Sep 1;180(5):445-53. Thorax. 2012 Apr;67(4):296-301.Singleton, JAMA. 2007;297:1784-1792 Eur Respir J. 2013 Dec;42(6):1659-67. J Thorac Oncol. 2013 Jul;8(7):866-75. N Engl J Med. 2011 Aug 4;365(5):395-409.
  21. 21. Inclusion criteria: • 55–74 years • ≥30 pack-years • Former smokers (within the previous 15 years) • LDCT vs. chest radiography – 3 annual rounds: T0, T1, T2 • For LDCT, noncalcified nodules of ≥4 mm (maximum diam.) - positive NLST Research Team, N Engl J Med 2011;365:395-409. LUNG CANCER
  22. 22. NLST Research Team, N Engl J Med 2011;365:395-409. LUNG CANCER
  23. 23. Aberle, N Engl J Med 2013;369:920-31. LUNG CANCER
  24. 24. PUBMED search March 2014. Number of publications related to the topic. LUNG CANCER
  25. 25. • LDCT diagnosed more cancer (1,1% vs 0,7%) • More stage I Ca in LDCT group • Tendency of stage-shift • Sensibility of LDCT 93,8% and Specificity 73,4% • In LDCT group more positive screenings and more Dg procedures NLST Research Team, N Engl J Med 2013;368:1980-91. LUNG CANCER
  26. 26. LUNG CANCER Aberle, N Engl J Med 2013;369:920-31. Data extracted from original
  27. 27. LUNG CANCER Aberle, N Engl J Med 2013;369:920-31. Data extracted from original
  28. 28. LUNG CANCER NLST Research Team, N Engl J Med 2013;368:1980-91. Sensitivity, specificity and positive predictive value for LDCT in T1 and T2. Data extracted from original
  29. 29. LUNG CANCER NLST Research Team, N Engl J Med 2013;368:1980-91. T0; Number of patients diagnosed of lung cancer according to Stage. Data extracted from original
  30. 30. LUNG CANCER Aberle, N Engl J Med 2013;369:920-31. T1; Number of patients diagnosed of lung cancer acording to Stage. Data extracted from original
  31. 31. LUNG CANCER Aberle, N Engl J Med 2013;369:920-31. T2; Number of patients diagnosed of lung cancer acording to Stage. Data extracted from original
  32. 32. LUNG CANCER NLST Research Team, N Engl J Med 2013;368:1980-91. T1; PPV according to lung nodule size. Data extracted from original
  33. 33. LUNG CANCER Aberle, N Engl J Med 2013;369:920-31. T2; PPV according to lung nodule size. Data extracted from original
  34. 34. LUNG CANCER Aberle, N Engl J Med 2013;369:920-31. T0; PPV according to lung nodule size. Data extracted from original
  35. 35. • Low-dose CT detects more lung cancers than radiography • Stage shift toward early-stage in non–small-cell lung cancers • Performance characteristics of low-dose CT may be enhanced LUNG CANCER LUNG CANCER: CONCLUSIONS Aberle, N Engl J Med 2013;369:920-31.
  36. 36. • Selection criteria –Detterbeck, CHEST 2013; 143(5)(Suppl):e78S–e92S –Kovalchik, N Engl J Med 2013;369:245-54 • Results may improve with the volumetric study –Horeweg, Eur Respir J 2013; 42: 1659–1667 • Results may also improve with pet-ct (>8mm) –Shlomi, Eur Respir J. 2014 Feb 13. • Awareness of concept of slow-growing lung cancer! –Infante, Eur Respir J 2013; 42: 1706–1722 • Biomarkers as additional screening tool –Sozzi, J Clin Oncol 2014 32:768-773. LUNG CANCER: MESSAGES 1 LUNG CANCER Detterbeck, CHEST 2013; 143(5)(Suppl):e78S–e92S Horeweg, Eur Respir J 2013; 42: 1659–1667 Shlomi, Eur Respir J. 2014 Feb 13. Infante, Eur Respir J 2013; 42: 1706–1722 Kovalchik, N Engl J Med 2013;369:245-54
  37. 37. Benefits • Effect on mortality • Effect on smoking behavior Harms • False positives • Diagnostic procedure complications • Overdiagnosis • Radiation exposure • Quality of life Screening could be performed such that benefits outweigh the harms. LUNG CANCER Bach, JAMA. 2012;307(22):2418-2429 LUNG CANCER: MESSAGES 2
  38. 38. INDEX • Pneumonia • Lung Cancer • Pulmonary Fibrosis• Pulmonary Fibrosis
  39. 39. PULMONARY FIBROSIS: INTRODUCTION PULMONARY FIBROSIS Navaratnam et al., Thorax 2011;66(6):462-7
  40. 40. PULMONARY FIBROSIS Kern et al., Ann Intern Med 1998;129(4):261-72
  41. 41. PULMONARY FIBROSIS Taken from: http://cxjinxing.en.alibaba.com/product/514495564-213102141/Nylon_flock_powder.html
  42. 42. PULMONARY FIBROSIS Turcotte, CHEST 2013; 143(6):1642–1648
  43. 43. PULMONARY FIBROSIS Navaratnam et al., Thorax 2011;66(6):462-7 PUBMED search March 2014. Number of publications related to the topic.
  44. 44. PULMONARY FIBROSIS Turcotte, CHEST 2013; 143(6):1642–1648
  45. 45. PULMONARY FIBROSIS Turcotte, CHEST 2013; 143(6):1642–1648
  46. 46. Natural history of FWL disease. Adapted from original PULMONARY FIBROSIS Turcotte, CHEST 2013; 143(6):1642–1648
  47. 47. • In summary, the natural history of FWL includes complete resolution; persistent, but stable ILD with a restrictive pulmonary function deficit; mixed obstructive/restrictive pulmonary function deficits; and progressive fibrosis leading to respiratory failure, pulmonary hypertension, and death. PULMONARY FIBROSIS PULMONARY FIBROSIS: CONCLUSIONS Turcotte, CHEST 2013; 143(6):1642–1648
  48. 48. PULMONARY FIBROSIS • Natural history of the interstitial lung diseases is not uniform and even can be reversed • It is important, when possible, to determine the cause of the disease –Am J Respir Crit Care Med. 2014 Jan 1;189(1):48-56. PULMONARY FIBROSIS: MESSAGES
  49. 49. PULMONARY FIBROSIS Thanks a lot!
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